摘要
应用超声生物显微镜 (UBM)检查技术 ,探讨非穿透性小梁手术联合透明质酸钠生物胶植入手术区域解剖特点和房水引流机制。方法 :对 14例 16只眼行非穿透性小梁手术联合透明质酸钠生物胶植入的患者 ,在术后 1～ 3个月内进行手术区域 UBM检查。检查的指标 (项目 )包括 :巩膜瓣下形成液间腔的大小 (宽和高 )、透明质酸钠生物胶吸收的情况、剩余角膜小梁膜的厚度以及滤过泡的形态 ,并对结果进行分析。结果 :16只眼术前平均眼压 2 3.43± 7.6 1mm Hg,术后 3个月时平均 14.6 5± 3.6 2 mm Hg,差异有显著性 (P<0 .0 1)。术后 1～ 3个月 U BM结果显示透明质酸钠生物胶尚未降解 ,所有病例在巩膜瓣下形成一透明液间腔 ,宽平均 3.2 0± 0 .91mm,高平均 0 .6 5± 0 .17mm。剩余角膜小梁膜厚度平均为 0 .0 8± 0 .0 7mm,如此层太厚 ,往往引起术后眼压升高。 5眼在结膜下伴有滤过泡形成。 1眼可见有脉络膜分离回声暗区。结论 :非穿透性小梁手术联合透明质酸钠生物胶植入降低眼压的机制是房水籍剩余的角膜小梁膜向包括了巩膜瓣下间腔、巩膜瓣周围、结膜下和脉络膜上腔引流的方式。手术的关键是充分切除深层巩膜瓣 ,残留菲薄角膜小梁膜 ,使房水自发性渗出。
To assess the anatomic outcome and the intraocular pressure(IOP)lowering mechanism of nonpenetrating trabecular surgery with sodium hyaluronate gel implant.Methods:Sixteen eyes of 14 patients with primary open angle glaucoma(POAG)were underwent nonpenetrating trabecular surgery with hyaluronate gel implant.Ultrasound Biomicroscopy(UBM) of the sclerectomy site was performed 1～3months after surgery.The following parameters were assessed:length and height of the transparent liquid space under the scleral flap,hyaluronate gel implant degration,thickness of the residual trabeculodescemetic membrane,and bleb appearance.Results:The IOP decreased from a mean preoperative value of 23 43±7 61mmHg to a mean postoperative value of 14 65±3 62mmHg(P<0 01).In all of eyes,UBM at 1～3months after surgery showed that the hyaluronate gel implant wasnt degradated and a transparent liquid space was formed under the scleral flap with a mean value of 3 20±0 91mm in length and 0 65±0 71mm in height.The thickness of remaining thin trabeculodescemetic membrane was 0 08±0 07mm with a mean value,which was consistent with intraocular pressure lowering.Subconjunctival filtration was seen in 5 eyes and a hypoechoic area in the suprachoroidal space was observed in 1 eyes. Conclusion:The UBM findings are consistent with IOP lowering by aqueous fitration through the thin remaining trabeculodescemetic membrace to an area under the scleral flap,which was maintained open by the hualuronate gel implant.The authors speculate that the aqueous humor then filtered through the thin scleral wall into the other tissue around the flap,suprachoroidal space,and subconjunctival space.Remaining intact thin trabeculodescemetic membrance is the key point of this surgery.
出处
《中国实用眼科杂志》
CSCD
2000年第8期477-479,共3页
Chinese Journal of Practical Ophthalmology
关键词
青光眼
非穿透性小梁手术
超声生物显微镜
Glaucoma Nonpenetrating trabecular surgery Sodium hyaluronate gel UBM
